Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | AP128923 | TX |
NPI | 1023485562 |
---|---|
Provider Name | Cheryl Bush |
First Address | Georgetown, TX 78626-6821 |
Second Address | Round Rock, TX 78665-3540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2015 |
Last Update Date | 10/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3526212-01 | (05) | TX |